Provider Demographics
NPI:1366670812
Name:DICLAUDIO, SHANDYN L (CRNA)
Entity Type:Individual
Prefix:
First Name:SHANDYN
Middle Name:L
Last Name:DICLAUDIO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHANDYN
Other - Middle Name:L
Other - Last Name:DICLAUDIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 4918
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32802-4918
Mailing Address - Country:US
Mailing Address - Phone:407-581-9180
Mailing Address - Fax:407-926-9173
Practice Address - Street 1:225 E ROBINSON ST
Practice Address - Street 2:SUITE #130
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-4322
Practice Address - Country:US
Practice Address - Phone:407-581-9180
Practice Address - Fax:407-926-9173
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9206405367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0013486 00Medicaid
FLG002GOtherBCBS
FL0013486 00Medicaid